High Anxiety- Adjusting to CPAP Life

[MyJanine]

Thank You, Fingers Crossed...

[englandsf]

That sounds very low compared to your charts. Pugsy?

[Jim-Bob]

That sounds very low compared to your charts. Pugsy?

I'm not Pugsy, but I did stay at a Holiday Inn Express last night.

Seriously, that modification (6 starting pressure to 7) is outrageous and moronic. After another month he will probably say take it from 7 to 8, and then 8 to 9, and so on. So you can expect some relief next Spring or so.

In fact it is such unbelievably bad and inadequate adjustment, I bet he never even looked at any detailed charts--just summaries.

You are clearly going to need a starting pressure well into the teens.

[Pugsy]

That sounds very low compared to your charts. Pugsy?

I haven't seen her reports so I don't know but maybe they are wanting to go up slowly and see how things respond.
Just because someone might end up needing a much higher minimum doesn't mean that they have to get there in one jump in a single night. For a newbie big jumps aren't so easy to get used to and especially if someone tends to be on the anxious side.

It never hurts to go up slowly when increasing the minimum even if we are pretty sure that there's a good chance a substantial increase is likely to be needed. Might get lucky and find out we don't need as much as we would have thought.

Since I haven't seen any reports from this OP I have no idea or thoughts as to what might be a suitable minimum pressure but it sounds like the doctor is aware and that's important. They likely will do 7 cm for a while and see what happens and then make any decision about how to proceed.

Besides...I have seen some rather remarkable improvements with something as simple as a little 1 cm increase...hurts nothing to go up slowly though.....the adjustment is easier and we might get lucky and not need so much anyway.

[Pugsy]

You are clearly going to need a starting pressure well into the teens.

Wow, your crystal ball must be superior to mine.
Where did you get it...I want one.

[Jim-Bob]

That sounds very low compared to your charts. Pugsy?

I haven't seen her reports so I don't know but maybe they are wanting to go up slowly and see how things respond.
Just because someone might end up needing a much higher minimum doesn't mean that they have to get there in one jump in a single night. For a newbie big jumps aren't so easy to get used to and especially if someone tends to be on the anxious side.

It never hurts to go up slowly when increasing the minimum even if we are pretty sure that there's a good chance a substantial increase is likely to be needed. Might get lucky and find out we don't need as much as we would have thought.

It seems to me that it can "hurt" to go slowly, if someone ends up living with seriously suboptimal therapy for long periods of time. If the chart shown is not at all representative of the OP's typical nights, that is one thing. If it is, on the other hand, she could be suffering for a long time with the "let's take it super slow" approach.

Since I haven't seen any reports from this OP I have no idea or thoughts as to what might be a suitable minimum pressure but it sounds like the doctor is aware and that's important. They likely will do 7 cm for a while and see what happens and then make any decision about how to proceed.

What leads you to think the doctor is aware? I don't see evidence of that.

Besides...I have seen some rather remarkable improvements with something as simple as a little 1 cm increase...hurts nothing to go up slowly though.....the adjustment is easier and we might get lucky and not need so much anyway.

The OP spent a good deal of time up in the mid to high teens and was still experiencing clusters of events even then. No doubt there are cases where a 1cm increase will accomplish quite a bit. But is there a realistic prospect that this is one of them?

I'm not trying to get into a debate here, and I respect Pugsy big time, but it seems to me that the doctor's approach is, let's say, overly conservative.

Paul J.

[Pugsy]

What leads you to think the doctor is aware? I don't see evidence of that.

This below leads me to believe the doctor is on board since this is what Janine said today..

The doctor finally called back and informed me the after reviewing my SD card data it appears I need to move the "pressure" from the 6 setting to the 7 setting.

I only saw one report and it didn't show me all I wanted to see and it's gone now....I would assume that the doctor saw more than what I saw. I also don't presume to know what his routine is for evaluating and making any changes that might be needed. I would certainly hope it would be more than once a month like you seem to think it will. Maybe he does a once a week thing...we don't know.

I also have my suspicions that 7 cm minimum isn't going to get the job done but I am not comfortable throwing out "in the teens" based on one night of crappy numbers and nothing else. If I did throw out "in the teens" I would also throw out "bilevel" in the same breath though and it would be after we had worked up from 7 cm proving that nothing else worked.

I prefer to see a lot more information and detailed reports before speculating much and since I haven't seen it and the doctor has....I prefer to defer to his thoughts until if and when I see something that proves he's an idiot.

[Jim-Bob]

What leads you to think the doctor is aware? I don't see evidence of that.

This below leads me to believe the doctor is on board since this is what Janine said today..

The doctor finally called back and informed me the after reviewing my SD card data it appears I need to move the "pressure" from the 6 setting to the 7 setting.

I only saw one report and it didn't show me all I wanted to see and it's gone now....

No, it's still there.

I would assume that the doctor saw more than what I saw. I also don't presume to know what his routine is for evaluating and making any changes that might be needed. I would certainly hope it would be more than once a month like you seem to think it will. Maybe he does a once a week thing...we don't know.

We know that the OP has expressed many misgivings about her doctor/HMO and his/their unhelpfulness.

We know that he has her snail mail her card and responds a week after that. So she is currently looking down the barrel of two weeks minimum at the current (non-)adjustment before there is even the chance of an actual adjustment that means something.

Since I haven't seen any reports from this OP I have no idea or thoughts as to what might be a suitable minimum pressure...

You had an idea earlier: "Probably going to need somewhere along the lines of where your median pressure is as a minimum pressure".

but it sounds like the doctor is aware and that's important. They likely will do 7 cm for a while and see what happens and then make any decision about how to proceed.

Yes, I fear the same.

I also have my suspicions that 7 cm minimum isn't going to get the job done but I am not comfortable throwing out "in the teens" based on one night of crappy numbers and nothing else. If I did throw out "in the teens" I would also throw out "bilevel" in the same breath though and it would be after we had worked up from 7 cm proving that nothing else worked.

I prefer to see a lot more information and detailed reports before speculating much and since I haven't seen it and the doctor has....I prefer to defer to his thoughts until if and when I see something that proves he's an idiot.

We saw him prescribe 6/20 and now 7/20.

The OP has been 100% compliant for 50 days (which is awesome!). She deserves better.

Paul J.

[Pugsy]

I seem to be having intermittent technical difficulties viewing report images as well as some links not working.
I still can't get the images here and I know they are here but I can't see them...it's happening on some other threads as well but not all threads.

Perhaps Janine can give us a new report with the new change to 7 minimum and let's see just how it looks. Hopefully I will be able to see it..
It's up to her if she wishes to stick to the doctor's apparent way of doing things or branch out on her own. I will support whatever she wishes to do.

No, it's still there.

[englandsf]

Her 95% pressure was 18.8 on the chart I looked at. That's why 7 seems too low to me. Wouldn't it take too long to catch up if it needs 18+?

[Pugsy]

Her 95% pressure was 18.8 on the chart I looked at. That's why 7 seems too low to me. Wouldn't it take too long to catch up if it needs 18+?

You are right. It will take too long at 7 minimum.
I can't see the reports that you all are seeing...I am having technical difficulties. For some reason I thought her median pressure was around 9 and not 18...and I don't go by 90/95% numbers unless they are long term. They are too easily manipulated.
She's going to need more than 7 cm minimum but we don't know why the doctor is going slow. Maybe he has his reasons.

It would be a disaster to take a newbie from 6 cm minimum to a 90% pressure of 18 cm in one fell swoop...maybe he is being extra cautious or something. We don't know what his plan is...so I am not comfortable totally trashing a doctor's plan without knowing what the plan is and giving him the benefit of the doubt. He might be a total idiot..but he might also have a well thought out plan that we aren't privvy to.

Even if the doctor wasn't involved I would still say go up slowly so that the adjustment process/period goes smoother. 1 cm for 2 or 3 nights...then another 1 cm ...and so on...unless the person was totally okay with a big leap in pressure. Some people are and some people aren't and somehow I sensed that this person who sounded overwhelmed and anxious would not do well with a big leap in pressure.

In the meantime I am having intermittent technical difficulties with some images and some links...and it's random...so I am trying to figure out what the problem is. I saw the reports initially in this thread but I can't see them now except I can see the one I posted as an example.

[Nick Danger]

OP's median pressure for one night of data was 11.1

[Pugsy]

OP's median pressure for one night of data was 11.1

Thank you. I couldn't remember exactly but I knew it wasn't up with the 90% pressure.
It's very possible that as the minimum pressure goes up that the 90% pressure will come down. I have seen it happen often. The machine doesn't have to play "fix it" so much if it does a better job preventing what it has been trying to fix. That 90% number isn't always what it is cracked up to be as what someone might need all the time. Especially when the minimum pressure is as low as it is in this situation. The machine isn't able to do much preventing and instead it's trying to "fix" things with so much pressure.

Also remember...the definition of 90/95 % pressures....at OR below that number. People tend to forget the "or below" part of the definition.

I suspect that the minimum needs to be up around where the median is but I would need to see several reports to make sure that was where I was leaning. I never base much of anything on just one report.

I am still having technical difficulties viewing some images and not others and accessing some websites and not others. I have exhausted any ideas I had to fix it. Going to bed. Last night was a really short night and I am feeling it. Maybe tomorrow my head will be clearer.

[Pugsy]

Ah...the prior image is now available again for me. The gremlins fixed it over night I guess. It was still absent when I went to bed...I did figure out it wasn't my computer because I used a totally different computer and was still having problems. I think maybe something to do with my internet connection.

The bulk of the AHI is in clusters and it appears to be maybe REM stage sleep. Of course it might also be related to pressure needs during supine sleeping. This AHI and this clustering reminds me so much of when I first started therapy and this could have been my report I was looking at when my minimum pressure was set to 8 cm. I ended up with 10 cm minimum being optimal for me but since would see occasional pressure spikes up near 20 I chose to leave the max wide open. Sometimes my 90% pressures would reflect that higher spike but the median pressures were always around 11ish and long term over 6 months my 90% pressures were more stable at around 12 cm.

So..for Janine I suspect that 7 minimum will improve things slightly but most likely not quite enough...and I suspect that something around 9 or 10 ish will do the trick and then she may be like me and have occasional spikes higher randomly. She may still see occasional nights with 90% number in the upper teens but I think that long term they won't be so high once that minimum gets up a little higher.
Without seeing several of the other nights of her reports we don't know if this one with the really high 90% pressure numbers is a fluke or something that was happening every night.

Now I don't know how quickly the doctor will move on things...that's his way of doing things. I would hope once a week and would encourage Janine to be proactive about making sure the doctor gets these results and not rely totally on a slow poke DME.

[MyJanine]

OK, Here's my one night at 7 pressure instead of the previous 6 pressure (thanks all the setting help).
Doesn't seem to have done anything. AHI is about the same and maybe even higher as I've had many nights in August with 5 to 6 AHI. Not seeing the pressure leak when I thought I got up to pee?
Here's a screenshot, Sleepyhead, Sept 2nd, last night: